The environmental dimension of antimicrobial resistance: informing policy, regulation and practice.

抗菌素耐药性（AMR）是导致病原体（如细菌）引起的感染治疗失败的现象。首席医疗官Dame Sally Davies教授将AMR构成的威胁与气候变化和全球恐怖主义进行了比较。如果目前的趋势继续下去，估计到2050年，AMR感染将成为主要的死亡原因，社会累计成本将达到100万亿美元。该知识交流奖学金的重点是细菌的耐药性，特别是环境在增加临床病原体耐药性方面的作用。AMR是古老的，在环境细菌中进化了数百万或数十亿年。随着进化时间的推移，耐药机制已经从环境细菌转移到人类病原体，这一过程被称为水平基因转移。AMR水平在受人类和动物废物影响的环境中很高，并且已知在诸如沿海浴场沃茨的环境中发生AMR细菌的显著暴露风险。然而，环境暴露和传播的相对重要性目前尚不确定，为政策和法规提供信息所需的证据的性质也不确定。KE奖学金旨在促进学术界、政府和工业界之间关于环境中AMR的知识交流，为政策制定、监管、缓解和降低风险战略提供信息。Defra，环境署（EA）和行业对该主题领域的知识交流有需求，因为联合国和世卫组织等组织迅速将其列为优先事项，并且未来可能会增加监管。Defra和EA是政策制定和监管机构，负责考虑环境中与AMR相关的证据，并且与制药和水行业一样是关键合作伙伴。还将与更广泛的利益攸关方进行知识交流，例如，保险业关注与AMR环境传播相关的潜在责任。将与Defra，EA，制药和水务行业进行一系列互惠知识交流，重点关注环境污染驱动的AMR演变，AMR的景观规模传播和环境传播给人类。这三个领域都涵盖了多个研究项目在博士凝视的实验室谁是独特的位置，以履行知识交流活动，由于他的研究组合，其中包括三个跨理事会倡议AMR赠款的范围。他的研究小组是国际上从事这一课题的最大的研究小组之一。他曾为英国政府和联合国提供咨询，并与制药和水行业有着密切的联系。在研究计划开始、中期及结束时，将分别举办三个工作坊，以确定幼儿教育的优先次序、评估进度及提出政策建议。将建立一个环境年度监测和报告网络，同时建立一个网站，提供网络资源和关于每一个科学问题的数据。一项关键活动将是与环境署合作，制定环境监测的协议和目标，因为目前的努力主要是基于研究，并且由于每个实验室使用不同的方法，因此不具有可比性。这是Defra和EA的一个关键目标，他们提供了大量的时间，通过该奖学金与学术界共同制定监督战略。产出将包括由所有伙伴共同设计的政策建议，以及一份报告和科学出版物，其中强调知识差距和当前政策执行的障碍。

Antimicrobial resistance (AMR) is the phenomenon that leads to treatment failure of infections caused by pathogenic organisms such as bacteria. The Chief Medical Officer Professor Dame Sally Davies has compared the threat posed by AMR to that of climate change and global terrorism. If current trends continue it is estimated that AMR infections will be the leading cause of death by 2050 with a cumulative cost to society of $100 trillion. This Knowledge Exchange Fellowship focuses on AMR in bacteria and specifically the role of the environment in increasing resistance seen in clinical pathogens. AMR is ancient, having evolved in environmental bacteria over millions or billions of years. Resistance mechanisms that evolved over evolutionary time have been mobilised from environmental bacteria to human pathogens through a process known as horizontal gene transfer. Levels of AMR are high in environments impacted by human and animal waste and it is known that significant exposure risk to AMR bacteria occurs in environments such as coastal bathing waters. However, the relative importance of environmental exposure and transmission is currently uncertain as is the nature of evidence required to inform policy and regulation.This KE Fellowship aims to facilitate knowledge exchange relating to AMR in the environment from, and between, academia, government and industry with the objective of informing policy making, regulation, mitigation and risk reduction strategies. There is demand from Defra, the Environment Agency (EA) and industry for knowledge exchange in this subject area due to its rapid prioritisation by organisations such as the UN and WHO and the probability that increased regulation may occur in the future. Defra and the EA are the policy making and regulatory agencies that are tasked with considering the evidence relating to AMR in the environment and are key partners as are the pharmaceutical and water industries. Knowledge exchange will also take place with a wider range of stakeholders, for example the insurance industry is concerned with potential liabilities associated with environmental transmission of AMR. A series of reciprocal knowledge exchange placements will take place with Defra, the EA, the pharmaceutical and water industries focusing on evolution of AMR driven by environmental pollution, land scape scale dissemination of AMR and environmental transmission to humans. These three areas are covered by multiple research projects within Dr Gaze's lab who is uniquely placed to fulfill Knowledge Exchange activities due to the scope of his research portfolio which includes three cross-council initiative AMR grants. His research group is one of the largest working on this subject internationally. He has advised UK government and the United nations and has strong links to the pharmaceutical and water industries. Three workshops will take place at the beginning, middle and end of the Fellowship to prioritise KE, assess progress and produce policy recommendations respectively. An environmental AMR network will be set up alongside a website with resources for the network and data on each of the scientific issues. A key activity will be to work with the EA to develop protocols and targets for environmental surveillance as current efforts are largely research based and are not comparable as each lab uses different methodologies. This is a key goal of Defra and the EA and they have offered significant time to co-develop a surveillance strategy with the academic community through this Fellowship. Outputs will include policy recommendations co-designed by all partners, and a report and scientific publication highlighting knowledge gaps and current barriers to policy implementation.